People with movement disorders can have a difficult time doing day-to-day activities, which could impact their independence. This can affect how people see themselves and affect their social life.
Ingrezza (in-GREH-zah) was approved in 2017 as the first medicine to help control movement in people with tardive dyskinesia and was approved for use in people with chorea caused by Huntington’s disease in 2023.
How Does It Work for Tardive Dyskinesia and Chorea?
Tardive dyskinesia (TD) is a condition that causes stiff, jerky movements that you cannot control and can affect your face and body. Certain medicines, such as antipsychotics or medicines for your stomach, can increase your chances of developing TD.
Chorea is a movement disorder caused by a hereditary condition called Huntington’s disease. Chorea can cause uncontrolled movements of the hands, feet, and face. A hereditary condition is a condition that is passed down from your parents. Huntington’s disease causes nerve cells in the brain to break down and cause thinking, emotional, and movement problems. Ingrezza helps manage uncontrolled movement due to chorea. It does not treat other symptoms of Huntington’s disease.
Ingrezza works to regulate the amount of dopamine signaling in your brain. Dopamine is a neurotransmitter that sends chemical messages between the cells in your brain and helps to control movement. Too much dopamine signaling in the brain is believed to cause uncontrolled movement. Ingrezza targets a protein called vesicular monoamine transporter 2 (VMAT2), which helps to release dopamine. This in turn reduces dopamine signaling and causes fewer uncontrolled movements.
How Do I Take It?
Ingrezza comes as a capsule and as a sprinkle capsule. The medicine can be taken with or without food.
If you are taking Ingrezza for TD, the recommended starting dose is 40 milligrams once a day, with a dose increase to 80 milligrams once a day (recommended dose) after 1 week. Your health care provider could consider a dose of 60 milligrams or 40 milligrams once daily depending on how you tolerate the medicine.
If you are taking Ingrezza for chorea, the recommended starting dose is 40 milligrams once a day with a dose increase to 60 milligrams after 2 weeks and another dose increase to 80 milligrams (recommended dose) after another 2 weeks. Your health care provider could consider a dose of 60 milligrams or 40 milligrams once daily depending on how you tolerate the medicine.
Ingrezza comes as a 40-milligram, 60-milligram, and 80-milligram capsule. Ingrezza also comes as a titration kit that contains a 4-week supply of the medicine with different doses. The titration kit allows you to start the medicine at a lower dose and increase your dose either 1 week or 2 weeks after starting the kit. Take Ingrezza as prescribed by your health care provider.
If you take the Ingrezza capsule, swallow the capsule whole. If you are taking Ingrezza sprinkle, your prescription should come with “Instructions for Use,” which can tell you how to take the medicine.
When you are preparing to take Ingrezza sprinkle, open the capsule and pour the contents of it onto a tablespoon of soft food such as applesauce, yogurt, or pudding. It is important to eat the soft food immediately after without crushing or chewing the sprinkles. Drink a glass of water (about 8 ounces) after taking the food/medicine mixture. If needed, the medicine/food mixture can be stored for up to 2 hours at room temperature. Throw away any unused medicine/food mixture after 2 hours. Do not add the sprinkles to milk or water.
How Was It Studied?
One study was conducted in people with TD and one study was conducted in people with chorea.
In the TD study, people with moderate or severe TD received either Ingrezza 40 milligrams, Ingrezza 80 milligrams, or a placebo containing no medicine. The study looked at the change in the Abnormal Involuntary Movement Scale (AIMS) score from baseline to week 6. The AIMS score looks at the severity of TD, with a higher score showing worsening symptoms. The average age of people in the study was 56. The study included White Americans, Black Americans, and those classified as “Other.” More than half of the people in this study were taking antipsychotic medicines.
In the chorea study, people received either Ingrezza (up to 80 milligrams) or a placebo containing no medicine. The study looked at the total maximal chorea score from baseline till the end of the treatment period (average of week 10 and week 12). The total maximum chorea score measures how severe a person’s chorea symptoms are, with a higher score representing worsening symptoms. The average age of people in the study was 54 and included White Americans, Black Americans, Asian Americans, and those classified as “Other.”
What Benefits Were Seen?
Tardive dyskinesia. People who took Ingrezza had some improvement in their AIMS score (-3.2 in the 80-milligram group and -1.9 in the 40-milligram group) compared to placebo (-0.1). This means Ingrezza helped to improve some uncontrolled movement symptoms compared to no medicine.
Chorea. People who took Ingrezza had some improvement in their total maximal chorea score (-4.6) compared to placebo (-1.4). This means Ingrezza helped to improve some uncontrolled movement symptoms compared to no medicine.
How Can I Tell If It Is Working?
In clinical studies, Ingrezza started to show improvement in symptoms in as little as 2 weeks. Ingrezza is working when you experience less uncontrolled movements. When you first start Ingrezza, your health care provider will start you on a low dose of Ingrezza and modify your dose from there. If you require many dose changes, it may take longer to see the effects of Ingrezza. Talk to your health care provider if you feel that your symptoms are not improving or are getting worse. Your doctor may increase your dose, add another medicine, or change you to a different medicine.
What Are the Possible Side Effects and How Can I Manage Them?
The most common side effect seen with Ingrezza in people with TD is drowsiness.
The most common side effects seen with Ingrezza in people with chorea are drowsiness, hives, rash, and trouble sleeping.
Ingrezza can cause drowsiness. It is important not to drive or perform any activities that require you to be alert until you know how the medicine affects you.
If you have a rash or hives from taking Ingrezza, these may be symptoms of an allergic reaction. Call your health care provider or go to the nearest emergency room.
Ingrezza can cause trouble sleeping. There are techniques that you may be able to implement to help manage this. Drinking less caffeine, including soda or coffee, trying to stick to a sleep schedule, using blackout curtains, and limiting screen time before bedtime can help.
What Type of Drug Interactions Can Happen?
Monoamine oxidase inhibitors (MOAIs) such as isocarboxazid, phenelzine, selegiline, and tranylcypromine are medicines used to treat depression or Parkinson’s disease. MAOIs should not be taken with Ingrezza and within 14 days of stopping an MAOI.
Taking digoxin (Lanoxin), a medicine used to treat some types of heart failure and irregular heartbeat, with Ingrezza may cause digoxin levels in the blood to increase, which can increase the risk of side effects. Your health care provider may monitor your digoxin blood levels while you are taking Ingrezza and may lower your digoxin dose if needed.
Taking Ingrezza with certain medicines called CYP3A4 and CYP2D6 inhibitors could cause Ingrezza blood levels to increase. Taking Ingrezza with a CYP3A4 inducer is not recommended. Talk to your health care provider about all the medicines you are taking. Your health care provider will determine if you are taking any of these medicines and may make any appropriate changes to either Ingrezza or your other medicines.
What Do I Need to Do to Get It?
Ingrezza is available through a select network of specialty and local affiliated pharmacies. A specialty pharmacy carries medicines that a regular pharmacy does not, particularly for more complex or rare conditions. The specialty pharmacy may mail your Ingrezza medication.
Is There a Cost-Savings Program?
There is a savings card that is offered by the manufacturer that may allow you to pay as little as $0 on your Ingrezza prescription. Whether you are eligible depends on the type of insurance you have. If you have TD, you can find out more at www.ingrezza.com/tardive-dyskinesia/savings-resources. If you have chorea, you can find out more at www.ingrezza.com/huntingtons-chorea/savings-support. You can also call 844-647-3992.
The manufacturer also has a free 1-month trial program for people who are starting the medicine. Your health care provider can assist you with enrolling in this program.
